The dialysis unit of STNM Hospital had to be sealed and de-sanitized for 48 hours Credit: Pema Wang Chen Lama

Gangtok:The COVID-19 pandemic has undoubtedly strengthened Sikkim’s Hospital sector while also highlighting many of its flaws. Adding another feather to its cap, STNM Hospital administered dialysis treatment or Renal Recovery Therapy on a COVID positive patient inside the COVID-19 section’s Central ICU at the hospital in Gangtok. The process had its challenges; however, a team of two nurses and a technician carried out dialysis for a regular dialysis patient from Tathangchen, a 60-year-old man, needing bi-weekly dialysis.

On September 2, the patient showed up for his routine dialysis session, but was found to be COVID positive when he was in a critical condition. Initially he was taken to the Emergency ward around 7 in the morning. “It was certain that without dialysis, he would not survive. After taking his Truenat sample, we had taken him for dialysis. Dialysis was for 5 hours, the Truenat report didn’t come immediately, but later it was positive. By that time we had conducted a normal dialysis in the Dialysis Unit of the Hospital”, said Head of Department for Medicine Dr BN Sharma, who has been administering dialysis in STNM Hospital and also in District Hospitals in the absence of a devoted Nephrologist in the state.

Following the report of the patient testing positive, the dialysis unit had to be sealed and de-sanitized for 48 hours. The hospital was unable to conduct dialysis session for other patients. “Once it was known that the patient was COVID positive, we shifted the patient to the COVID ward. But there was a need for continuation of his bi-weekly dialysis. We were unable to administer dialysis for a COVID positive patient, so we made a provision for dialysis machine to be set up for the patient in the Central ICU inside the COVID section of the new STNM Hospital. The same was carried out for the patient on Saturday evening for 6 hours, it was a new development, and the patient is doing fine”, shared Dr Sharma with EastMojo.

The same has set an example, where there are chances of more dialysis needing patient turning up to be COVID positive. “We were devoid of options at the moment. A critical patient cannot be taken to Geyzing District Hospital or Namchi District Hospital, where the dialysis units have been set up. The easier and logical option was on setting up a dialysis machine inside the Central ICU where critical COVID patients are being treated. Now such emergencies can be managed in Central ICU, with one of dialysis machine. Even if a patient develops any kidney failure despite being COVID positive, the machine will come in handy for future cases as well”.

The patient in contention was in consultation since July this year, with Dr Sharma. “When we sealed the dialysis unit for those 48 hours, we are now reeling with a backlog for the next 5 days, as the patient count for dialysis is huge currently. Now, there is another COVID positive patient needing dialysis, who has been identified as a contact of the Tathangchen patient on September 2 in the dialysis unit. This second patient is from Pakyong, he is in his late 50s, and the same will be carried out today”, stated Dr Sharma.

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For setting up the dialysis unit in the Central ICU, there was some civil work needed for water supply. “When we conduct a dialysis session, we need Reverse Osmosis Water. A water line was connected to the Central ICU, with proper drainage. We had to bring in plumbers. Everyone is scared to enter the COVID-19 ward, so we made the plumbers wear PPE suits.”

The dialysis was administered by one technician and two nurses present at the Central ICU. “As per the protocol, we give the order after checking the vitals of the patient, we check on the weight gain, checking all the parameters, we give the order to the technician. The team in Central ICU was catering the services along with COVID unit Medical Specialists currently”, stated Sharma.

The dialysis unit is functioning routinely. Since March, patients needing dialysis who were in other states for treatment were flown back home; therefore, there is an unprecedented increase in the number of patients needing dialysis. “There is an average of 24 patients who are administered dialysis daily— divided into three shifts from morning, afternoon and late evening with eight dialysis machines at disposal in STNM Hospital. We are unable to send them to Siliguri with the COVID-19 lockdown and also to Central Referral Hospital in Manipal, as they are facing a shortage of technicians. All patients, needing emergency dialysis are also being brought to STNM Hospital, which affects the daily shift count for other patients, beyond the 24 patients every day. We were doing two shifts previously, only in morning and afternoon, now depending on caseload it extends till midnight”, shared the senior doctor.

STNM’s dialysis unit has 10 machines, of which two are devoted to Hepatitis and HIV positive patients, but they have been facing mechanical failure. Now another machine has been shifted to Central ICU, so the dialysis unit is struggling with only 7 machines, bringing down the average dialysis sessions as well for patients per day. There are still 200 patients in the waiting list for dialysis session in STNM, informed the doctor.

However, a welcome initiative recently has been the setting up of dialysis unit in Geyzing, West Sikkim. Patients from West Sikkim are being administered dialysis in the Geyzing District Hospital and Namchi District Hospital for South District, with each of the district hospitals having 5 dialysis machines. “The district hospitals are now catering to patients who have come from outside the State. They are kept in a quarantine facility. Namchi is running two shifts, with patient load increasing they may go for 3 shifts as well”.

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On the need for Nephrologist in the state, Medicine Specialist Dr BN Sharma stated, “If we intend on doing renal transplant in the state, we will require a nephrologist. With the Hospital being a super speciality, it is better to have a nephrologist; it will be good for the public”.

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